News : Gates speaks to Vinton Noon Kiwanis concerning Home Birth

Area Midwife Bethany Gates of Shiphrah Birth Services spoke to the local Kiwanis about homebirth

Alexa Spiedel, the County Recorder became aware of Bethany Gates because of her job which includes recording the Vital Records, which includes births that occur in Benton County. Because Virginia Gay Hospital no longer delivers babies, there is rarely a birth to record. Spiedel said that there have probably only been 15 births to record since 2014, and now they only get home births.

Gates is a Certified Professional Midwife (CPM) and the owner of Shiphrah Birth Service here in Vinton. Gates provides a type of maternity care that many people aren't aware is an option: home birth. Gates has an office at 217 North K Ave. in Vinton. She is able to offer prenatal care to mothers there before they deliver their babies. Following a 5-year apprenticeship and clinical training that included attending about 90 births in a student midwife or doula capacity, Gates then sat for her national board exam in April of that year and gave birth to her 4th daughter in May of that year. She laughed as she said she finished up her training just in time to go on maternity leave.

She addressed the Noon Kiwanis Club at their Tuesday meeting and spoke about birthing babies at home. For the younger crowd, she explained that births used to always happen at home. A midwife would attend the birth and assist the mother. She shared a bit of the history of obstetrics and how it changed home births around the turn of the century. She said the doctors began to come into the homes and observe the midwives so that they could learn from them and then they took what they had learned into the hospital setting.

That's where she says that doctors began to change the way that birth looked. It started with a natural mindset with midwives at home, then progressed to a more medicalized approach. She shared that by the mid-1900's, "Twilight Births" were often occurring in hospitals. These were births by women who were put to sleep and then their babies were delivered. In the 70s and 80s, there was a movement by women to be able to be awake and part of the birth. She said the effort made it clear that women wanted other women to be an active part of their own births. Midwifery began to pick up steam about this time in the United States.

In Iowa, there are three different types of midwives that practice, Gates said. There are traditional midwives, trained via the traditional apprenticeship model. This midwife type is often found in the Mennonite and Amish communities. There are Certified Nurse-Midwives, who are trained in a hospital setting. Certified Professional Midwife is the third type, and is the category that Gates falls under. These midwives are trained specifically in out-of-hospital births. They train in homes and birth centers. They train in the art of normal, physiological birth. Gates explained that in home birth, there isn't the choice for epidurals, IVs, and there is limited access to provide other medical interventions. Her training, she explained, focuses on recognizing normal, and the things that fall outside of that scope. With that training, she can make a timely transfer to a hospital when something comes up.

Across the nation, she said about 1.5% of women choose to have their babies at home. In Iowa, that number equates to about 550 women each year. Because of COVID, she said that she has seen her practice double it's usual number of clients, and midwives across the state have experienced the same surge. It is unusual for women who give birth at home to choose a hospital setting again unless a complication arises prenatally that risks them out of home birth.

Gates shared that her first daughter was born in the hospital, her second was born at home with two midwives in attendance, the third birth was delivered by her husband because the midwives missed the birth by 10 minutes, and the last was attended by her midwifery partner.

Her desire to become a midwife began after her first home birth. What struck her the most was that in the hospital, she said you are put onto what she describes as their conveyor belt. As soon as you walk in, she explained, the same procedures are done on every woman. The hospitals have their own standards and procedures, but it's not individualized to the woman. She explained that if you come in as a low-risk patient, you will still be expected to go through many of the same procedures as a high-risk mother.

With a home birth, the midwives discuss with the mothers their health, nutrition, how the baby is doing, and the birth plans of the parents. Prenatal care for mothers follows the same schedule as you would with a medical doctor. Visits are typically made every 4 weeks, up until 28 weeks, and then every 2 weeks until 36 weeks and every week until delivery. She also offers lab work, ultrasounds, screening for gestational diabetes, and other testing options as medically indicated. She said that visits last anywhere from 45 minutes to an hour. Longer, more personalized visits is another advantage to home births.

Doulas, she explained are birth coaches, while Midwives provide the necessary medical training. The Doula role is different than midwives as they are not responsible for the care of the mom and baby. A midwife is trained in neonatal resuscitation, CPR, and managing hemorrhages. The midwives generally do not attend births prior to 37 weeks gestation.She is able to consult with hospital-based maternity care providers if something happens that she needs advice or if an emergency arises.

She explained that about 10% of those who plan for a home birth, need to be transferred to a hospital. Most are non-emergency transfers and are usually for the first time moms who are having a long labor and need an epidural and some rest.

Dads always ask, "How messy is this?" She tells the dads, "The only evidence that you'll have after we leave the house, is that there is a newborn baby there." She does provide the families with a list of the necessary supplies that they need for the birth. Sometimes families request pools for birth so she has that available as well. She said that part of the job as a midwife is to make sure that everything is cleaned up before they leave.

"What about an emergency?" Gates said that is usually one of the first questions that she gets when discussing home births. Her training helps her to screen for risks beforehand. The prenatal care, she shared, is to make sure that the mom and baby are both low-risk. She said that it's very rare to have an emergency at home, but if one should occur, she is trained to manage them until help via an ambulance can arrive. In her 4 years of practicing, she hasn't had an emergency transfer. While they do happen, they are rare.

Another reason she said mothers are choosing to have their babies at home is because of the cesarean birth rates. Nationally, 33% of women who enter the hospital will deliver via a c-section. Home births have a 5% rate of c-sections, a dramatic difference. In her practice, Gates said that she's had one cesarean delivery in the last four years which puts her practice at about a 2% average. She said of course that's partially luck, but still drastically below the national average.

Interventions in delivery with midwives in both a hospital setting and at home are also lower. Trusting the women's body to function as physiologically it is designed to do, trained midwives often encourage the women rather than intervene in the delivery unless medical indications arise that let let them know intervention is needed. She explained that while obstetricians often come into a high-risk birth, they are trained surgeons, so they might see the delivery differently than a midwife. Midwives tend to believe that birth, for low-risk women with low-risk pregnancies will, most of the time, result in a natural birth with a healthy mom and baby if you let nature take its course.

She said after seeing some of her friends share some of their stories about hospital births, seeing how limited Iowa was in options, and hearing of her own mother's dramatic delivery experiences it drove her to explore the midwifery options.

Iowa ranks 49th in the nation for maternity care providers per woman who need them. Right now she said a lot of the small-town hospitals in Iowa are closing their maternity care options so the Iowa midwives are asking the Iowa Legislature to help by making the laws much more friendly to midwives. Around the world, Gates explained that a midwife increases good maternal healthcare outcomes and decreases maternal and neonatal deaths. In the United Kingdom, she explained that it's just assumed that you will have a midwife for delivering a baby and OB's are only called in if there's a complication. She said that the United States runs about 20 years behind the UK in all things medical, so there is hope that across the United States, there will eventually be more access to midwives.

The cost for a homebirth ranges anywhere from $4-6,000. Some insurance companies will reimburse some of the cost. Christian Healthcare Sharing Ministries will often fully cover the cost. Some of those typically include Medishare and Samaritan Ministries. Blue Cross/Blue Shield, depending on your plan she said will reimburse some of the cost. However, state Medicaid does not cover any of the cost, which is another reason the Iowa midwives are trying to expand the laws in Iowa. She explained that a normal birth in a hospital setting costs the state around $20,000.

Gates covers any area between Iowa City and Cedar Falls or about an hour and a half radius from Vinton. She said that there are requests that come in from outside of that radius but she just cannot do that. Right now she's taking up to 4 or 5 clients per month. Since she started her practice in 2017, she's attended about 60 births. She mentioned that 2 a.m. is the prime time to receive a labor call.

If you'd like to connect with Gates, click here.